AbstractObjectives:Thromboembolic complications are well recognized during the endovascular management of intracranial aneurysms. In this study, we present a case series of 40 patients with intraprocedural thrombotic complications who were treated with intra-arterial eptifibatide (IAE), and a review of the literature. Methods:Twenty-five patients with ruptured intracranial aneurysms (RIA), 10 with unruptured intracranial aneurysms (UIA) and 5 with aneurysmal subarachnoid hemorrhage-induced vasospasm (VSP) received IAE for intraprocedural thrombi during endovascular treatment. Rates of recanalization, strokes, and hemorrhagic complications were assessed. Results:Recanalization was achieved in 96 (24/25) of the RIA patients [72 (18/25) complete; 24 (6/25) partial], in 100 (10/10) of the UIA patients [90 (9/10) complete; 10 (1/10) partial], and in 100 (5/5) of the VSP patients [80 (4/5) complete; 20 (1/5) partial]. Strokes following intraprocedural thrombosis were coil-related (20, 5/25) or stent-related (12, 3/25) in RIA patients, stent-related (10, 1/10) in UIA patients, and heparin-induced thrombocytopenia type II-related (60, 3/5) or vasospasm-related (20, 1/5) in VSP patients. There were no intracerebral hemorrhagic complications in UIA. Intracerebral hemorrhage was observed in 20 of the RIA patients (5/25), all of whom had received intra-arterial thrombolytics and/or high-dose heparin infusion in addition to IAE; in 12, this was external ventricular drain-related (3/25), 4 had parenchymal hematoma type 1 (1/25), and 4 parenchymal hematoma type 2 (1/25). One of the 5 VSP patients, who had received argatroban in addition to IAE, had parenchymal hematoma type 1. No clinically significant systemic hemorrhage was observed in this study. Conclusion:Treatment of thromboembolic complications with IAE during endovascular management of aneurysms was effective in achieving recanalization and overall well tolerated in this series.© 2013 S. Karger AG, Basel